| NPI | 1184624652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 026153) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 4395) |
| 163W00000X Registered Nurse (Licence: NY N15520) | |
| 164W00000X Licensed Practical Nurse (Licence: NY 347302) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2025-11-03 |